Recurrent Spasmodic Croup-Like Episodes With Cough-Predominant Symptoms in an Atopic School-Aged Child: The Importance of Integrated Upper- and Lower-Airway Management.

Recurrent spasmodic croup is uncommon in school-aged children and may reflect an atopy-associated upper-airway dysfunction rather than a viral illness. We reported a 14-year-old boy with perennial allergic rhinitis and cough-predominant asthma who experienced 10 early-morning episodes of barking cough and inspiratory stridor between 2020 and 2024. Despite the long-term prescription of inhaled corticosteroid therapy, seasonal discontinuation and inconsistent adherence were evident, and recurrent episodes persisted. After referral, integrated management including stepwise allergic-rhinitis treatment and re-education promoting year-round adherence was implemented. Although the direct impact of these interventions on episode recurrence could not be determined, cough symptoms improved and asthma control stabilized despite persistently elevated fractional nitric oxide (~60 ppb). Integrated upper- and lower-airway management and adherence optimization may help stabilize cough-predominant symptoms in atopic children.